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HomeMy WebLinkAbout0008 ERIN LANE - Health p 8 Erin Lane , Hyannis =' A g ql r S O 4 } eei R a + Health Department Drop-Off Hours: 8:00 AM -4:30 P.M Torun of Barnstable v . Received by Health a Fi►E gYti Regulatory Services Department on Richard V.Scali,Director MAM 1659. Public Health Division E ""p Thomas McKean,Director „ .y 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE . Property Address:, Assessor's Map/Parcel Number: Applicant(s) Name: V� I u 1, l�}�� �L✓ �e�� Phone: E-Mail: U&(W(T0, r 6 Size of Lot: � 2a. How many bedrooms exist at your property now? 2b. How many bedroom are you planning to add as part of the Accessory Affordable Apartment Program application? 2c. How many bedrooms total are proposed at this property(including the Accessory unit)? ,2 2e. Is the proposed Accessory Apartment contained within: . j !/the main house; OR a detached.structure 2f. Submit floor plans for all buildings on the entire property. g P P rty Show all existing rooms in the dwelling and the proposed accessory apartment. Label each room clearly. Label measured width of all open doorways. Use straight edge for hand drawn plans and be sure all labeling is legible. Signed: - ,� .�— C'�� ; ,,,� Date: ol. oQn i ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE FOR STAFF USE ONLY 1. Is the dwelling connected to Town sewer? ❑ Yes Q No 2. Dwelling located ©/INSID lg OUTSI the Saltwater Estuary Protection Zone 3. Dwelling locat ❑ OUTSIDE public supply well Zone of Contribution 4. Dwelling is connected to ❑ ON-SITE WELL ZkfUBLIC WATER 5. Disposal works construction permit on file? [fifes ❑ Nog3 6. If yes, how many bedrooms were allowed by this permit: 2 bedrooms 7. Were building permits obtained for additional bedrooms? ❑ Yes [ No 8. Engineered septic system plan: a. On file at the Health Division? es ❑ No b. If proposed accessory unit is detached from principal dwelling, is that plan on file? ❑ Yes ❑ No 9. Existing septic system capacity is bedrooms For the accessory unit to receive approval from the Health Department the following action must occur: • Existing system accommodates proposed additional bedroom(s) ❑ Upgrade existing system to accommodate additional bedroom(s) Er'Must remove a bedroom from the main house,.C4'nvev'kj -6 ❑ Must connect detached structure to the existing septic system ❑ Must install septic system for the detached structure ❑ Other Signed Date s J D �v Jn� oS� 4b4W JrOLIVS G)0-0M 6 2 ��Pt Li V ) NJ nEb now Y - K2 GPETC I NTa e ���C�c %• •��-� CP�ifirjE� L7C�tL 1 LVVNJS Al2C-� d LI �' m�I 12,&- /�C�•U i2.r'�I Lf ti e� ° roe, Sj -\- - f fe7 I n 1 C � rKi J 3 z Ph NsaX -ellClo n ►1 O i I f - ..---._._._..---.......... ........................_....____.. .............. ..., c I 1 i G 0" M, , o" � P 1 �7 1 F� CIO •��p,�� �i.. � .� � .,, .. ..... a..__.., 1 Rom` WA. i N WJ V 41 �- I +O Y V aY� try-- ' r� � t o . , 'm f.f a' �� . v 0- fz tj =., , #�M-TIFUo"D 1 PLAN i. • -IRTIFY -THA.T.. WHAT.: ON. T PLAID .' � . p O�TN E r0� ap and loV'numb*r'-:: P ,s ' SEI�71cs'yw XHouse e Permit num'be `,�,:.a.• •• • "' S *+��**,��,LLERa� co number .. . . � ...:...... ................ P . NMENTAL CO() a�a �OYaY� tc bff =T :N O x•-x;a. „. € e..... �� .. ; BUhL DIN G INSPECTOR t:: • ' .. .. \, � . .................... . ......... ..:::.. .............................. APPLICATION- FOR PERMIT TO: ................ ....... ................ TYPE OF CONSTRUCTION ... ....z ..........19.�?. TO THE INSPECTOR-OF BUILDINGS: The undersigned hereby applies for a permit according to the foll wing information: ���C ..:......... .............................................', ,� ................................... Location """"' ..... ... . . ProposedUse ................... :............. "?�' lct............................................................I.................... ..... Fire District ........ ..... .... . ........... Zoning District ........... Address ..•���.�z... Name of Owner •• .� .............................. ...................... ................................... Name of Builder .........................................Address ...................... ......Address ............................................... Name of Architect ................. ..................................... Foundation? - ..:............................................................ Number of Rooms ................ ... . .. ..... mod.......Roofing .....� r�`[� ? ................................................... Exterior n ............ CJ Interior .... .CC :.................................... c.u, Floors ................... ...... G /T Heating :Ltd • L?�a ... �• ............Plumbing .............�.. `................................................ Y4 Approximate Cost ........�..... .. d13......................................... Fireplace ............................• i / Area ..:`...:..Cr.................... Definitive Plan Approved by Planning Board ---------- —�--- Diagram of Lot and Building with Dimensions SUBJECT TO APPROVA OF BOARD OF HEALTH M , �o�'c TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .231 Parcel C®O Permit# Health Division "f 8f� c Date Issued 6 s Coi9servation Division - SRNEASLE- Fee Tax Collector JU 20 PM 12: 45 Application Fee Treasurer Planning Dept. 01V1 1 `"— Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address r,1 ® Z_ ,6 O/ r Village _ Zia W4136E Owner �"o fVA _Address C� ,�!-N 1 .nJA_7 4!Z�✓�✓f� . Telephone. fl8 Permit Request a ® -1b U i zZ A: 1 t-� ! C-7 J4 /7 267& Se A iaZ> &E�' Oeiy)7 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation 5�5-O0 ov Zoning District Flood Plain 91 I A Groundwater Overlay Construction Type ���.��c�P t2.� c e:a Lot Size Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) y Age of Existing Structure Historic House: ❑Yes polo On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl &Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 0 N C— new Half: existing 006 new Number of Bedrooms: existing _-Z, new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas 21b"i ❑ Electric ❑Other Central Air: ❑Yes 3410 Fireplaces: Existing New Existing wood/coal stove: ❑Yes . ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA D2601 (Town Hall) DATE:`IA Fill in lease• iKv r <r APPLICANT'S YOUR NAME/Y. r fa�_ BUSINESS YOUR HOME ADDRESS: &,c i,n H k 4ca n n l:5rn A CLQ6G 1 ` TELEPHONE # Home Telephone Number 45n - ro S a2 1 lFY .3.+YSyLJ 1 ...... NAME OF CORPORATIO . 1 CI NAME OF NEW BUSIN TYPE OF BUSINESS G PC4 n n, :aQ G�. IS THIS A HOME OCCUPATIO ? �, Zot=H YES ADDRESS OF BUSINESS _' 02 6n I MAP/PARCEL NUMBER oZ q l - O/1- J01(Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 4 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business.. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been i r ed of the p it re r ments that pertain to this type of business. S MUST COMPLY WITH ALL COMMENTS: Ao ' ed ignature* Hp,7ARD0USMATERIP►LSREGULAT!C-"" ` 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) �r This individual ha info f licens' g requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date: `1 / GJ / 10 TOWN OF BARNSTABLE TONIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS:,A-y[°.� 2t d C k°-a jo n c aq C n BUSINESS LOCATION: Z r4 7 Gr2 . .� clnni�s 0-2 Cp a l INVENTORY MAILING ADDRESS: 6 '26 TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 0-)4 4 n n L'/7 Q CA - INFORMATION/RECOMMENDATIONS: Fire District: a Waste Transportation: — Last shipment of hazardous_waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons. Lacquer thinners (inc. carbon tetrachloride) - -NEW USED T _ Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor& furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS exp am wriatyou discussed with ern. Hazardous Materials Inventory Sheet Checklist -(/ Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to �elean brushes all count as hazardous materials-no-blanks) 1 ,/ Storage Information - location of storage,how long is storage for? f none, note that. isposal Information -where and who? If none, note that. pplicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedurpcz _.rininn nloket ..,...,4+_ k— r 1" e� 1 J F;1 � r^ r` tv O C 9-a �X P Qtiy V 3 r G x f 9 A ,O IJ, Oo r � r r � �-�--------ter{ C s�+ i F- IN + < IT, \ _ �n � b 5 C � � a k 6 'N C11-OD Abo � � r _ _ ---- -- .........._ _....._. � d�C►. Lrx� T .�. V000, Commonweotth of Mosmctwsetts _ Executive Office of Erivlronment�al-Affairs John Graci - D:E.P: Title V Seplic Inspector - - Department of. _ P.0.Box 2119. ��!'e�'1l�1@nta Protection Teaticket,MA 02536 Envy (508)- -6913 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A J CERTIFICATION Property-Addressr- 8 Erin Lane Hyannis Address of Owner Date of.Inspection:8120196 - (If different) P �c Name of Inspector:John Graci _ Guglleimi Ck� Company Name,Address and Telephone Number. CERTIFICATION.STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes Conditionally Passes _ Needs Fur er aluation By the Local Approving Authority Fails �7 I Inspector's Signature: Dater 8120196 The System Inspector shall su mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A. B,C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe.basis of determination in all instances. If "not determined",explain why not.) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic.fank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE DISPOSAL SYSTEM UBSURFACE SEWA INSPECTION FORM PART A - _ CERTIFICATION (continued) - Property Address: 8Erin Lane Hyannis Owner: Gugilelml Date of Inspection:8(40196 ii royal of the Board of Health): . _ -wage backup or breakout or high static-water ley ass nspectiontife(with approval on box is due to a broken, Se g settled or uneven distribution box. The system. P broken pipe(j)are replaced obstruction is removed" . distribution_box is leveled or replaced - tem required pumping more than four"times as daof ue to br ken or obstructed pipe(s)• The The sys approval of the Bo system will pass inspection if(with broken plpe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REr1UiREp BY THE BOARD OF HEALTH: in order to determine if the Conditions exist which require further:evaluation by and Board sen�ronment. system is failing to protect the public health, safety - NES THAT THE SYSTEM 1) SYST EM WILL PASS UNLESS BOARD OF HEALTH ROTECTrTHE PUBLIC HEALTH AND SNOT FUNCTIONING IN A AFETY AND THE ENVIRONMENT:WHICH WILL Cesspool or privy is within 50 feet of a surface wate retated wetland or a salt marsh. Cesspool or privy i s within 50 feet of a bordering 9 DETERMINES UBLIC WATER SUPPLIER, IF APROPRIATE) 2) SYSTEM WILL FAI L UNLESS THE BOARD OF HEALTH (AN PROTECT THE PUBLIC HEALTH APND SAFETY AND THE THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT ENVIRONMENT: stem and is within 100 feet to a _ The system has a septic tank and soil absorption water supply. Y surface surface of water supply or tributary to a s "on system and is within a Zone 1 of a public water The system has a septic tank and soil absorption Y eet of a private water supply well: _ The system has a septic tank and soil absorption system and is within„a f100 feet but 50 feet or more from a private supply well. The system has a septic tank and soil absorption system and is less ce of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.. ter supply well, unless a well water analysis fon coliform bacteria volatile organic compounds indicates that the well Is water presence free from.pollution for that facility and the p 3) OTHER D] SYSTEM FAILS: _ _ I have determined that the system violates one or more identified below. The of the following failur Board of Health should be e criteria as defined in 310 CMR 15.303. The basis for this determination contacted to determine what will be necessary to correct the failure. ed SAS or Backup of sewage infacility or system component.due loan overloaded or clogged cesspool. or onding of effluentto the surface of the ground or.surface waters due to an overloaded or clogged Discharge P _ . cesspool. SAS is in hydraulic failure. Via: I. (revised 1 Ill 5196) n - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM_ PART A CERTIFICATION(continued) Property Address: 8 Erin Lane Hyannis Owner: - Gugllelml Hate of Inspection:8120196 — _ D]_SYSTEM FAILS(continued) Static liquid level in the distribution box above outlet invert-due to an overloaded",or clogged SAS or cesspool. _ Liquid depth incesspool is less than 6°below invert or,available volume is less than 1/2 day, flow. - i Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). _ Numbers of times pumped _ - Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria` _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. { (revised 11115195) :b �� 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART B CHECLIST _. --- Property Address: 8 Erin Lane Hyannis _ Owner: cugnelmi Date of Inspection:8120196 - Check iff the following have been done: _ x requested of the owner,occupant, and Board of-Health. Pumping information was the system recently or as part of this components have been pumped for at leoa�been ntro.duced into thehe and sy system has been receiving normal X-None of the system P _ flow rates during that period. Large volumes of water have n r -inspection. n obtained and examined. Note if they are not ava nlags built plans have bee ilable with NIA. X The facility or dwelling was inspected for signs of sewage back-up. on-sanitary or industrial waste flow. X The system does not receive n X The site was inspected for signs of breakout. I system components,excluding the e. Soil Absorption System,have.been located on thWast respected X All Y opened, and the interior of the septic tank depth of scum. X The septic tank manholes were uncovered,op th of.liquid,depth of sludge, for condition of baffles or tees,material of construction,dimensions site has de beendetermined based on existing information or X The size and location of the Soil Absorption System on the . approximated by non-intrusive methods. maintenance of Sub- nee)were provided with X The facility owner(and occupants,if different from ow information on the proper Surface Disposal System. rCa 7 � (revised 11115195) I 4 q4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C -- - = SYSTEM INFORMATION - Property Address: 8 Erin Lane Hyannis - Owner: -Gugllelml _ Date of inspection:9120196 - FLOW CONDITIONS - RESIDENTIAL:- Design flow: 220 gallons --- Number-of-bedrooms: 2 Number Of current residents:_ Garbage grinder(yes or no): N Laundry connected to system-(yes or no): Yes Seasonal use(yes or no): Yes - - Water meter readings,if available: n1a Last:date of occupancy: ft - C )MMERCIAL/INDUSTRIAL: en t. n1a Type of establishm Design flow:o gallons/day Grease trap present:(yes or no) No r, Industrial Waste Holding Tank present: (yes or no) NO es or no) No - Non-sanitary waste discharged to the Title 5 system: (y - Water meter readings,if availabl e: n1a Last date of occupancy: Na OTHER: (Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: system has not been umped in the last two um fears- System Pumped as part art of inspection:(yes or no)No P I if yes,volume pumped:o gallons i' Reason for pumping: n!a i TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool , Overflow cesspool _Privy cords,if any) Shared system(yes or no):(if yes, attach previous inspection re Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: less Sewage odors detected when arriving at the site:(yes or no) No e ra�t I (revised 11115195) r SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM _ PART C - SYSTEM INFORMATION(continued) Property Address:. 8 Erin Lane Hyannis _ Owner: .— Guglieiml —. Date of 1nspection:8120196 - SEPTIC TANK: X - (locate on site plan) Depth below grade:5" Materiarof construction:X concreate,_metal-FRP_other(explain) -- L 8,8•H 5'7•w 4'1t1' I Dimens _ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: o - Scum thickness:4• Distance from top of scum to top of outlet tee or baffle:B• of outlet tee or baffle: 14• Distance form bottom of scum to bottom Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc..) system every two years for maintenance. Septic tank and ail components are structurally sound.Recommend pumping GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Di stance from top of scum to top of outlet tee or baffle:nra Distance from bottom of scum to bottom of outlet tee or baffle: n/a. Comments: of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, (recommendation for pumping,condition evidence of leakage,etc.) Na (revised 11115195) 6 t - -_-- -- -- - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) _ Property Address: 8 Erin Lane Hyannis Owner:— Gugilelml - Date of inspection,8120196 - TIGHT OR-HOLDING TANK: (locate on site plan) - - Depth below grade:Va Material of con struction:_concrete_metal FRP_other(explain) Dimensions: n1a - Capacity: -rda gallons _ Design flow: nfa gallons/day Alarm level: nla Comments: (condition of inlet tee, condition of alarm and float switches, etc.) nla DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid level with bottom of pipe Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or oufof box etc.) The d-box is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n1a I (revised I1115/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C - SYSTEM INFORMATION(continued) Property Address: 8 Erin Lane Hyannis. Owner: �gugilelmt - Date of Inspection:=0106 SOIL ABSORPTION SYSTEM (SAS):x - (locate-on site plan,if possible;-excavation-not required,,but may be approximated by non-intrusive methods) If not determined to be present, explain: Na Type: - leaching.pits, number: 1,000 gallon leach pft leaching chambers,number:n/a - .leaching galleries, number: n1a leaching trenches,number, length: Na leaching fields, number, dimensions:nfa overflow cesspool, number:nla Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The sas is structurally sound and functioning properly. CESSPOOLS:— (locate on site plan) Number and configuration: nfa Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: n1a Materials of construction. nfa Indication of groundwater: nfa inflow(cesspool must be pumped as part of inspection) nla Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) n1a PRIVY: (locate on site plan) Materials of construction: nla Dimensions: nla Depth of solids: n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PrivyComments (revised 11115125) '}SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. 8 Erin Lane Hyannis Owner: Cugllelml - _ Date of Inspectlon::812a198 SKETCH OF_SEWAGE.DISPOSAL SYSTEM: _ include ties to-at least two permanent references landmarks or benchmarks locate all wells within 100' - 70 a C�. 0 A� 13 g AD3yy � �04 �p a9 DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS MAPS AND CHARTS (revised 11115195) 9 I LOCATION SEWAGE PERMIT NO. �*� -*V V I L L A G E p't9/� 61t7-06/ INSTALLER'S NAME A ADDRESS d U I L D E R OR OWNER DATE PERMIT ISSUED 8Z1 � Zcg3 DATE COMPLIANCE ISSUED O �� �, �, � o � ,� z � � �� a w o w L. . . �,, N..A_3. ✓ t t f ." Fims....7�:................. THE 450M it$4WEALTH OF MASSACHUSETTS BOARD OF HEALTH 7�A........................OF. Ar��. c��4� — Yll ApplirFa#ion for Disposal Works Tomilrnrtion rami# Application is h eb made for a Permit t Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address V or Lot No. �S �G dce��n S.0 as F� v.�S _._.. - ! . .. ---- - - - •-- �r Owner , 1 ...................................................... .. i.. � /cow-• Installer Address d Type of Building Size Lot...... ...:................Sq. feet Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ..... No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures .................................. Design Flow........ ............................gallons per person per day. Total daily flow........IaO........................gallons. 9 Septic Tank—Liquid capacity..dCo'?_gallons Length.%:"'.. Width--- Diameter---------------- Depth_!l��... Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------...........Diameter.�L X—)R­P Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................... ••••--••-......-•••-••-••••......•••. Date........................................ aTest Pit No. 1.................minutes per inch Depth of Test Pit.....® ......... Depth to ground water......................... G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-••----••---------------------•--••---•••..........••-•--...................._......-----•------•--......................................................... 0 Description of Soil-•G'=a....l-crxw..-.....-`3....S coy.. ------3 -------------• x x ----•---------- •--•----------•••---•---•--•----•----------•---••---------------•-------••-•-----•-•---••---••••---------•--••----•-•--•-•-----•----•••--•••-•---•-••----•-------••---••-•-..._._....... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----•-••• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of SIT E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha been issued by the,bo .d of health. ned -•--------------••...........•-• ._.. ApplicationApproved By..._ -- --�-------------------------------------------•------............--------------- ��-�--.... ...�-•------ Date Application Disapprove or a following reasons-----------------------•---------------------------------------•-----------------•----•-•---•--••-•-•••........_ -•--------------------------•-------------------....------------------------------------------------...-----•-•....-----••••-••••••••---••-----•-•---------•--•----••---••----•----- Date PermitNo--------------------------------------------------------- Issued....................................................... Date FE No.. .!� :s l s.... �.............. THE (!OMM0?4WEALTH OF MASSACHUSETTS Q,(ErA'-RD OF HEALTH � a,�I�r?OJT.............. ........OF 0.r %A.01k ....---------•--..... ApplirFation for MipaiiFal Vorki Tomitrnrtion .erntit "Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ r-1 �ocation Address or 1Lot No ..............................................t.Ct- + S=�t aV1 A Ls Owner 4 Addre =a :t 4t ^ a n c)w-c- t � } � Installer Address �` d Type of Building w Size ------------Sq. feet Dwelling—No7—o-f m ................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ..... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .........--•••--••-••--••-----•- . ..:..- -- Il - . W Design Flow........__.0............................gallons per person per day. Total daily flow.......=- �%4 ......................._gallons. W Septic Tank—Liquid*uid ca acit .. � t_ '' >!' `' ' �` r :t p q p y _gallons Length.�.._� __ W>dth__:P._�4�_.... Diameter................ Depth a:._��....... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.____....1.......... Diameter. ...X::' :...� Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I...5�L........minutes per inch Depth of Test Pit-----61........... Depth to ground water........................ 0;4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -•----••--•----------••--------------•--;: •••------•------------.......-•--------•-................---••-•-•--•--.........---- •-- Description of Soil_.---- .] `....-- --!..... +1 `f `'ua-emu,. ----• x ............................................................. W ••••-------------------------------•----------•--•-----------------•-------•--•--•----•-----•-----------------••---•---------•-----••----•-•--•------................................................ Nature of Repairs or Alterations—Answer when applicable............................................................................................... 3 .....................••........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A ITIE 5 of the State Sanitary Code— The undersign further agrees not to place the system in operation until a Certificate of Compliance ha en issued b th lyl ofsbealth. ' ed. .. ........................ . ...� ...Z�.....:3... D ApplicationApproved By------ '------. ='........................•------•-= ...--••-••................_...--•-• .... - --- .--'g--........ . Date Application Disapprove or following reasons---------------------•-----------•-------------•--------•---•--------------------------------------•••-----..._.. ...................•--------•-......----•--•---•------------...----•-........-----------...------------•.-•-•-----------------------------•-----•-------------------•-------------•--•--•----...._.... Date PermitNo.................:.....•----...-•-•----..._......------• Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................. Trrtif iratr of ToutlrliFanrr T T E IFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by { ... --..... ------. nst """ /Ri --- at--------- -------•----......----------..... - =------ _ . ------ has been installed in accordance with the provisions of TITLE 5 f T.l�tate Sanitary o as E b, m the application for Disposal Works Construction Permit No._ _"_, ;;.ff............. da.ted__I�_:_ ._ _` ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS RANTEE THAT THE SYSTEM 19NIL U ION SATISFACTORY. DATE.....Z� . ------------------------------------------------ Inspector.......... --------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF �U No......:... .... v.... FEE.. ..........---_.... # 1 � � �trnrti�an rrnttt PermissionA�OtRyel granted.-- �..le-.....:. . --.---••-•---•••-•-------•---•----•......--•----•-----•-•-to Construc a' -( ) an�Indivi e Disposal osal System ' � Street 4�as shown on the application for Disposal Works Construction Permit No.._.___.�;•�;._ .... ... ................. ... ------ ----r------------------- _ ;i�oard of Health DATE. ................................................. J FORM 1255 HOSES & WARREN. INC.. PUBLISHERS_.I i s SOIL LOG NO. 1 0 NO. 2 SITE PLAN LOAM 1 e - 3 I 4 00 TOP OF FOUNDATION EL.: /010'A *`.' Ujn&F-r, ( z ' A6ov� .� '� 5 j f • Mix. C�✓ 2_ ./ ;��r�._ 7 i e � �?to ��D'�£'. !•}�°'lr. € -�.liLttt ivTT ��'R��s I • �14 bIAT (7 Nr-PY-ram C'IT2 ft `8 9 I • 97,b 10 • • Ltt�rE e• 1 f IN.EI. -- 1 to. I N.E l. 3� I N.E L. ' 8 _ __ ---�--- — __ i � _� 5 ,t�suT 12 ` .! O/B W/ 6" SUMP : E Y ONE 13 4' LIQUID LEVEL 14 15 • r 3 PERC TEST RESULTS l PRECAST SEPTIC TANK WITH ' w ' PERC RATE . � � P�2�G���i LEAC��1�G P►'i S -------- f: ., ., WHITNESSEO BY: CAST IN PLACE INLET AND �-� --- - -- - 1 ..._ ..� . _ r � F >� L;x• ;�_ OUTLET T "S PER TITLE Y I OF SrOtJC - -- — BOARD OF HEALTH C SIZE : r ,A><. 'u �, �;� y�r;s w H�Gr; ---- - 'p�%r. .__�, 1 DATE: __ l I PROFILE OF PROPOSED SEWAGE SYSTEM SYSTEM DESIGNED BY THE TOWN OF � ___.°i___..._,_—_ REGULATIONS AND i STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE = 1/4"= 1 ' 0" f I 1. ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE � 2. ALL PIPES SHALL BE SLOPED 1/4" PER FOOT EXCEPT FOR THE FIRST 2 FEET OUT OF THE O / B WHICH SHALL BE LEVEL ` � ? 3. DESIGN FLOW BEDROOMS AT 110 GALDAY PER BR . __.-__-_ GAL/DAY 1 . SEPTIC TANK SIZE _ - X :_ GAL. _ / _ ' ' GARBAGE DISPOSAL — - �D PLE�USE - GAl. W gt; LEACHING SYSTEM : - i USE � C (��t�lG;tt�ai�r F"r V C _ w a7E rz EFFECTIVE AREA : SIDE BOTTOM ,�:? :� — ry TOTAL FLOW-------..-. TOTAL REQ'D FLOW __? X _ _ _ - __ _?z O W/ ' GARBAGE DISPOSAL — - RESERVE FLOW 1:- GAL/ DAY_._ _-----____-- f .: I REFERENCE PLANS : 612 -T5 -- '— --- — ieLe APPROVED BY BOARD 0 F HEALTH EA : _ 1 DATE ti , � S , `tt,lf"1'•��S PROPERTY OWNER : 11 IVA Ll .. ia,. tr - a 1. .. .... s . .-„ r:.,.'... .�. ..•..:. ,' .ate ...F,`t _ . �^ -. v . _ ,.